Bariatric surgery and diabetes:Current challenges and perspectives

Diabetes mellitus(DM)and obesity have become public issues of global concern.Bariatric surgery for the treatment of obesity combined with type 2 DM has been shown to be a safe and effective approach;however,there are limited studies that have systematically addressed the challenges of surgical treatment of obesity combined with DM.In this review,we summarize and answer the most pressing questions in the field of surgical treatment of obesity-associated DM.I believe that our insights will be of great help to clinicians in their daily practice.

Bird species composition and conservation challenges in the Gaoligong Mountains, one of the most diverse bird areas in the world

The Gaoligong Mountains(GLGM),located in southwestern China,extend north to south along the western border of the Hengduan Mountains,spanning approximately 600 km.In this study,we consolidated findings from 17 bird surveys conducted in the GLGM between 2010 and 2022.We found that the GLGM harbors tremendous bird diversity,with a total of 796 documented bird species in the region.Nearly a quarter(23.0%)of these species are listed as state key protected species or as Chinese and global threatened species.Analysis of species richness at the county level showed a decreasing trend with increasing latitude,with the greatest diversity in Yingjiang(661 species).Observations indicated that the GLGM belongs to the Oriental realm,primarily composed of bird species from southern and southwestern China.The GLGM plays an important role in avian conservation by sheltering exceptional bird diversity,providing corridors and flyways for bird migration and dispersal,and mitigating the effects of climate change.In response to the conservation needs of birds and other wildlife,the Chinese government has established numerous protected areas within the GLGM.Despite these efforts,avian conservation still faces considerable challenges in the GLGM due to limitations in the protected area network,transboundary nature of the regions,and existing gaps in monitoring and research.

Potential applications of 7 Tesla magnetic resonance imaging in paediatric neuroimaging:Feasibility and challenges

The integration of 7 Tesla magnetic resonance imaging(7 T MRI)in adult patients has marked a revolutionary stride in radiology.In this article we explore the feasibility of 7 T MRI in paediatric practice,emphasizing its feasibility,applications,challenges,and safety considerations.The heightened resolution and tissue contrast of 7 T MRI offer unprecedented diagnostic accuracy,particularly in neuroimaging.Applications range from neuro-oncology to neonatal brain imaging,showcasing its efficacy in detecting subtle structural abnormalities and providing enhanced insights into neurological conditions.Despite the promise,challenges such as high cost,discomfort,and safety concerns necessitate careful consideration.Research suggests that,with precautions,7 T MRI is feasible in paediatrics,yet ongoing studies and safety assessments are imperative.

Navigating interdisciplinary research:Historical progression and contemporary challenges

Interdisciplinary research plays a crucial role in addressing complex problems by integrating knowledge from multiple disciplines.This integration fosters innovative solutions and enhances understanding across various fields.This study explores the historical and sociological development of interdisciplinary research and maps its evolution through three distinct phases:pre-disciplinary,disciplinary,and post-disciplinary.It identifies key internal dynamics,such as disciplinary diversification,reorganization,and innovation,as primary drivers of this evolution.Additionally,this study highlights how external factors,particularly the urgency of World War II and the subsequent political and economic changes,have accelerated its advancement.The rise of interdisciplinary research has significantly reshaped traditional educational paradigms,promoting its integration across different educational levels.However,the inherent contradictions within interdisciplinary research present cognitive,emotional,and institutional challenges for researchers.Meanwhile,finding a balance between the breadth and depth of knowledge remains a critical challenge in interdisciplinary education.

Promise and challenges of traditional Chinese medicine,specifically Calculus bovis,in liver cancer treatment

Liver cancer,one of the most common malignancies worldwide,ranks sixth in incidence and third in mortality.Liver cancer treatment options are diverse,inclu-ding surgical resection,liver transplantation,percutaneous ablation,transarterial chemoembolization,radiotherapy,chemotherapy,targeted therapy,immuno-therapy,and traditional Chinese medicine(TCM).A multidisciplinary team(MDT)is essential to customize treatment plans based on tumor staging,liver function,and performance status(PS),ensuring individualized patient care.Treatment decisions require a MDT to tailor strategies based on tumor staging,liver function,and PS,ensuring personalized care.The approval of new first-line and second-line drugs and the establishment of standard treatments based on immune checkpoint inhibitors have significantly expanded treatment options for advanced liver cancer,improving overall prognosis.However,many patients do not respond effectively to these treatments and ultimately succumb to the disease.Modern oncology treatments,while extending patient survival,often come with severe side effects,resistance,and damage to the body,negatively impacting quality of life.Huang et al's study published at World Journal of Gastroenterology rigorously validates the anticancer properties of Calculus bovis,enhancing our understanding of TCM and contributing to new liver cancer treatment strategies.For over 5000 years,TCM has been used in East Asian countries like China to treat various diseases,including liver conditions.Analysis of real-world clinical data suggests that for patients with advanced-stage tumors lacking effective treatments,integrated TCM therapies could provide significant breakthroughs.

Assessment of Barriers and Challenges to the Screening and Linkages of Non-Communicable Diseases by Community Health Volunteers in Nyeri County, Kenya

Non-communicable diseases (NCDs) are a significant global health challenge, contributing to 50% of worldwide morbidity and 63% of mortality. The burden is particularly substantial in low—and middle-income countries (LMICs), where 80% of NCD-related deaths occur. A quasi-experimental study addressed this challenge from May 2022 to March 2023. This study utilized a non-equivalent pre-and post-test design, with 300 participants in the quantitative and 70 in the qualitative. The study employed multistage cluster and random sampling to select ten community units, resulting in 150 community health volunteers (CHVs) in the control unit and 150 in the intervention group. Data collection was facilitated through the KOBO app. Qualitative data analysis involved six homogeneous focus group discussions (FGDs) and ten key informant interviews (KIIs), audio-recorded, transcribed, and analyzed using N-Vivo 12. Despite efforts to implement screening programs and improve linkages to care, significant barriers persist. This article reviews these barriers, drawing on current literature and empirical evidence. Key obstacles identified include limited awareness, inadequate healthcare infrastructure, cultural beliefs, financial constraints, fragmented healthcare systems, and challenges linking individuals to appropriate care services. The article explores strategies to overcome these barriers, emphasizing the importance of collaborative approaches involving stakeholders at various levels. Addressing these challenges aims to strengthen NCD screening and linkages to care, ultimately improving health outcomes for populations globally. Several recommendations emerge from the study’s findings and literature review. Raising awareness about NCDs and preventive measures is crucial and can be achieved through targeted health education campaigns and community outreach programs. Addressing healthcare infrastructure deficiencies, such as inadequate facilities and workforce shortages, is essential to ensure access to quality care. Cultural beliefs and practices also play a significant role in shaping health-seeking behavior. Engaging with local communities and incorporating cultural sensitivity into healthcare delivery can help bridge the gap between traditional beliefs and modern healthcare practices. Financial constraints pose a significant barrier to healthcare services, particularly in LMICs. Innovative financing mechanisms, such as health insurance schemes or subsidies, can help alleviate this burden and improve access to care. Furthermore, the fragmented nature of healthcare systems can hinder effective NCD management. Enhancing coordination and integration between primary care providers, specialists, and community health workers is essential to ensure seamless care delivery and patient follow-up. Finally, strengthening linkages between screening programs and care services is critical for the timely diagnosis and management of NCDs. This requires establishing robust referral systems and ensuring continuity of care for patients throughout their healthcare journey. In conclusion, addressing the multifaceted barriers to NCD screening and care linkage is essential for improving health outcomes globally. By implementing targeted interventions and fostering collaboration among stakeholders, progress can be made towards reducing the burden of NCDs and promoting population health.

Recognizing and addressing the challenges of gastrointestinal tuberculosis

In this editorial,we comment on the article by Ali et al published in the recent issue of the World Journal of Clinical Cases.This case report shed light on a particularly rare manifestation of this disease-primary gastrointestinal tuberculosis(GTB)presenting as gastric outlet obstruction.GTB presents diagnostic challenges due to its nonspecific symptoms and lack of highly accurate diagnostic algorithms.This editorial synthesizes epidemiological data,risk factors,pathogenesis,clinical presentations,diagnostic methods,and therapies to raise awareness about GTB.GTB constitutes 1%-3%of all tuberculosis cases globally,with 6%-38%of patients also having pulmonary tuberculosis.Pathogenesis involves various modes of Mycobacterium tuberculosis complex entry into the gastrointestinal system,with the terminal ileum and ileocecal valve commonly affected.Clinical presentation varies,often resembling other intra-abdominal pathologies,necessitating a high index of suspicion.Diagnostic tools include a combination of biochemical,microbiological,radiological,and endoscopic assessments.Antitubercular medication remains the cornerstone of treatment,supplemented by surgical intervention in severe cases.Multidisciplinary management involving gastroenterologists,surgeons,pulmonologists,and infectious disease specialists is crucial for optimal outcomes.Despite advancements,timely diagnosis and management challenges persist,underscoring the need for continued research and collaboration in addressing primary GTB.

Stem cell-based ischemic stroke therapy:Novel modifications and clinical challenges

Ischemic stroke(IS)causes severe disability and high mortality worldwide.Stem cell(SC)therapy exhibits unique therapeutic potential for IS that differs from current treatments.SC’s cell homing,differentiation and paracrine abilities give hope for neuroprotection.Recent studies on SC modification have enhanced therapeutic effects for IS,including gene transfection,nanoparticle modification,biomaterial modification and pretreatment.Thesemethods improve survival rate,homing,neural differentiation,and paracrine abilities in ischemic areas.However,many problems must be resolved before SC therapy can be clinically applied.These issues include production quality and quantity,stability during transportation and storage,as well as usage regulations.Herein,we reviewed the brief pathogenesis of IS,the“multi-mechanism”advantages of SCs for treating IS,various SC modification methods,and SC therapy challenges.We aim to uncover the potential and overcome the challenges of using SCs for treating IS and convey innovative ideas for modifying SCs.

Tuberculosis-diabetes comorbidities: Mechanistic insights for clinical considerations and treatment challenges

Tuberculosis(TB)remains a leading cause of death among infectious diseases,particularly in poor countries.Viral infections,multidrug-resistant and ex-tensively drug-resistant TB strains,as well as the coexistence of chronic illnesses such as diabetes mellitus(DM)greatly aggravate TB morbidity and mortality.DM[particularly type 2 DM(T2DM)]and TB have converged making their control even more challenging.Two contemporary global epidemics,TB-DM behaves like a syndemic,a synergistic confluence of two highly prevalent diseases.T2DM is a risk factor for developing more severe forms of multi-drug resistant-TB and TB recurrence after preventive treatment.Since a bidirectional relationship exists between TB and DM,it is necessary to concurrently treat both,and promote recommendations for the joint management of both diseases.There are also some drug-drug interactions resulting in adverse treatment outcomes in TB-DM patients including treatment failure,and reinfection.In addition,autophagy may play a role in these comorbidities.Therefore,the TB-DM comorbidities present several health challenges,requiring a focus on multidisciplinary collaboration and integrated strategies,to effectively deal with this double burden.To effectively manage the comorbidity,further screening in affected countries,more suitable drugs,and better treatment strategies are required.

Unveiling the challenges encountered by newly graduated nurses during night shifts:A descriptive qualitative study

Objectives:Newly graduated nurses commence night shifts during a phase of heightened vulnerability to reality shock,exacerbating the challenges faced by these graduates.Therefore,this study aimed to identify the challenges experienced by newly graduated nurses when undertaking night shifts in order to help identify a strategy for supporting their adaptation to these shifts.Methods:Semi-structured personal interviews were used to collect data.Fifteen newly graduated nurses were selected to participate in the study by purposive sampling method from November 2021 to March 2022 in one of four general hospitals situated in the southwestern region of Japan.Semi-structured interviews were analyzed by using thematic analysis.Results:The analysis revealedfive central themes and nine subthemes:challenges in task efficiency(task organization challenges,challenges in time-constrained task performance),challenges in responding to patients’changing conditions(challenges in responding to patients’irregular conditions,challenges in responding to nighttime changes in patients’behaviors),challenges in independent practice(challenges in engaging in independent nursing practice,challenges in dealing with unexpected events),challenges in establishing collaborative relationships(challenges in working closely with other staff,challenges in establishing collaborative relationships during night shifts with limited resources),challenges in adapting to shift work(challenges in managing physical conditions for shift work).Conclusions:Newly graduated nurses often encounter challenges in performing their tasks during the transition period.When working night shifts,they face additional hurdles unique to nocturnal duties.Thefindings underscore the necessity for these graduates to develop night shift-specific readiness to effectively navigate the demands inherent in such work schedules.

Conversion therapy for unresectable hepatocellular carcinoma:Advances and challenges

Recently,the World Journal of Gastrointestinal Oncology published an article entitled“Pathologically successful conversion hepatectomy for advanced giant hepatocellular carcinoma after multidisciplinary therapy:A case report and review of the literature”,in which the authors shared their successful experience with complete surgical resection after multidisciplinary conversion therapy.The study by Chu et al demonstrates the great challenges that the advanced hepatocellular carcinoma(HCC)poses to surgical oncology,reveals the complexity of conversion therapy for unresectable HCC,emphasizes the important role of a multidisciplinary management model in conversion therapy,and enriches our understanding of the dynamics of personalized treatment for different patients.At present,conversion therapy is a hot research topic in the treatment of unresectable HCC,which has brought new hope to many patients with moderately advanced HCC.However,there are still many urgent problems to be solved in conversion therapy.Here,we would like to further discuss the advances and challenges of conversion therapy for unresectable HCC with the authors and the general readers.

Diagnostic challenges from conflicting results of tests and imaging

Accurate diagnosis is the foundation of clinical care but accurate diagnosis is not easily reached in some cases.In rare instances,even a sophisticated multidisciplinary team at an academic medical center cannot reliably reach an accurate diagnosis after extensive testing and imaging,and has to wait until histological diagnosis or even autopsy results are available.The underlying reason of challenging diagnoses is mostly conflicting data from history,tests,and imaging that point to different diagnoses.In this issue of World Journal of Clinical Cases,Huffaker et al reported such a challenging case of a tricuspid mass in a patient with Li-Fraumeni syndrome.The case by Huffaker et al powerfully illustrates the occasional diagnostic challenges inherent in our current diagnostic approach and the current technology.Clinicians should realize that in rare situations,agnosticism in diagnosis is unavoidable but a treatment has to be initiated so long as the principle of primum non nocere is upheld.

Security and Privacy in Solar Insecticidal Lamps Internet of Things:Requirements and Challenges

Solar insecticidal lamps(SIL) can effectively control pests and reduce the use of pesticides. Combining SIL and Internet of Things(IoT) has formed a new type of agricultural IoT,known as SIL-IoT, which can improve the effectiveness of migratory phototropic pest control. However, since the SIL is connected to the Internet, it is vulnerable to various security issues.These issues can lead to serious consequences, such as tampering with the parameters of SIL, illegally starting and stopping SIL,etc. In this paper, we describe the overall security requirements of SIL-IoT and present an extensive survey of security and privacy solutions for SIL-IoT. We investigate the background and logical architecture of SIL-IoT, discuss SIL-IoT security scenarios, and analyze potential attacks. Starting from the security requirements of SIL-IoT we divide them into six categories, namely privacy, authentication, confidentiality, access control, availability,and integrity. Next, we describe the SIL-IoT privacy and security solutions, as well as the blockchain-based solutions. Based on the current survey, we finally discuss the challenges and future research directions of SIL-IoT.

Diagnostic and management challenges in primary cutaneous anaplastic large cell lymphoma with necrosis,inflammation,and surgical intervention:A case report

BACKGROUND Primary cutaneous anaplastic large cell lymphoma(PC-ALCL)poses significant diagnostic difficulties due to its similarity in the appearance of skin lesions with chronic inflammatory disorders and other dermatological conditions.This study aims to investigate these challenges by conducting a comprehensive analysis of a case presenting with PC-ALCL,emphasizing the necessity of accurate differentiation for appropriate management.CASE SUMMARY An 89-year-old female patient with diabetes and hypertension presented with arm and abdominal ulcerated mass lesions.Diagnostic procedures included skin biopsies,histopathological assessments,and immunohistochemistry,complemented by advanced imaging techniques to confirm the diagnosis.The patient’s lesions were determined as PC-ALCL,characterized by necrosis,chronic inflammation,and a distinct immunophenotypic profile,including CD30,CD3,CD4,and EBER,CD56,MUM-1,Ki 67-positive in>80%of tumor cells,CD10,but negative for anaplastic lymphoma kinase,CD5,CD20,PAX-5,Bcl-2,Bcl-6,CD8,and CD15.Recurrence was not reported at the 6-month follow-up.CONCLUSION Accurate PC-ALCL differentiation from similar conditions is crucial for effective management and requires a multidisciplinary approach.

Colorectal cancer screening:The value of early detection and modern challenges

The screening of colorectal cancer(CRC)is pivotal for both the prevention and treatment of this disease,significantly improving early-stage tumor detection rates.This advancement not only boosts survival rates and quality of life for patients but also reduces the costs associated with treatment.However,the adoption of CRC screening methods faces numerous challenges,including the technical limitations of both noninvasive and invasive methods in terms of sensitivity and specificity.Moreover,socioeconomic factors such as regional disparities,economic conditions,and varying levels of awareness affect screening uptake.The coronavirus disease 2019 pandemic further intensified these challenges,leading to reduced screening participation and increased waiting periods.Additionally,the growing prevalence of early-onset CRC necessitates innovative screening approaches.In response,research into new methodologies,including artificial intelligence-based systems,aims to improve the precision and accessibility of screening.Proactive measures by governments and health organizations to enhance CRC screening efforts are underway,including increased advocacy,improved service delivery,and international cooperation.The role of technological innovation and global health collaboration in advancing CRC screening is undeniable.Technologies such as artificial intelligence and gene sequencing are set to revolutionize CRC screening,making a significant impact on the fight against this disease.Given the rise in early-onset CRC,it is crucial for screening strategies to continually evolve,ensuring their effectiveness and applicability.

Realm of hepatitis E:Challenges and opportunities

Hepatitis E virus(HEV),responsible for widespread viral hepatitis,infects approximately 2.3 billion individuals globally,with a significant mortality burden in Asia.The virus,primarily transmitted through contaminated water and undercooked meat,is often underdiagnosed,particularly in immunocompromised patients.Current HEV treatments,while effective,are limited by adverse effects,necessitating research into safer alternatives.Moreover,HEV’s extrahepatic manifestations,impacting the nervous and renal systems,remain poorly understood.This study underscores the imperative for enhanced HEV research,improved diagnostic methods,and more effective treatments,coupled with increased public health awareness and preventive strategies.

Performance Evaluation of Low-Cost Dual-Frequency GNSS Receivers for Precise Positioning in Senegal: Issues and Challenges

The development of this technology has favored the advances noted in recent years in the field of precise positioning. It has also paved the way for a wide range of research into the evaluation of their performance and reliability, their potential use in different fields, the improvement of performance and combined systems, etc. Single-frequency GNSS receivers, which for a long time remained the only category of low-cost GNSS receivers, often limited by their level of accuracy (metric) mainly due to their single-frequency nature, have been joined in the last decade by dual-frequency GNSS receivers developed by certain manufacturers of positioning equipment. These receivers now offer possible alternatives to the relatively expensive conventional (topographic quality) or geodetic receivers and. In this study, the performance of these low-cost dual-frequency receivers was evaluated in static and real-time kinematic GNSS positioning modes. Static positioning was carried out on three points with sessions of 2 h and 4 h over three days with antenna swapping (CHC i50, Leica GS14 and Emlid Reach RS2+). Real-time observations were carried out on eleven (11) points in open, poorly open and not at all open environments, in order to assess not only performance but also receiver sensitivity in environments with a high risk of multipath. The results obtained showed an average agreement of 2 cm in planimetry between the low-cost Emlid RS2+ receiver and the Leica GS14 and CHC i50 receivers. The differences in altimetry are nevertheless greater (sometimes up to decimetres for certain points). Real-time positioning results provided an average convergence of around 1 cm on the E, N and H components with the results from the low-cost Emlid Reach RS2+ and Ublox ZED-F9P receivers and the CHC i50 receiver. Analysis of the results obtained has enabled us to highlight the various issues and challenges associated with this new generation of GNSS receivers, with a view to enhancing their appropriation and optimal integration in the professional and research worlds.

Interdepartmental miscommunication regarding radiology:Addressing chronic challenges and exploring solutions

Effective communication and collaboration among healthcare professionals are crucial for delivering high-quality patient care.Interdepartmental miscommunication poses a significant challenge to healthcare systems,potentially undermining the quality of healthcare services provided.In the same manner,communication barriers between referring physicians and radiologists can specifically affect radiology services and patient outcomes.This article attempts to put the spotlight on the ever-present chronic challenges of this issue and prompt readers to recognize the relevant potential pitfalls in their daily clinical practice.Practical solutions are explored and proposed,which should be tailored to the specific needs and issues that each individual institution may face.

Impact of Social Media Challenges on Pediatric Single-Use Detergent Sacs and Diphenhydramine Ingestions Reported to United States Poison Control Centers

Background: Social media platforms are popular among children and often feature challenges that become viral. Notably, the Tide Pod® and Benadryl® challenges encouraged viewers to ingest these substances for their visual appeal and hallucinogenic effects, respectively. This study aimed to assess the clinical impact and outcomes of single-use detergent sacs (SUDS) and diphenhydramine challenges on pediatric ingestions reported to United States (U.S.) Poison Control Centers (PCCs). Methods: We conducted a retrospective review of pediatric exposures reported to U.S. PCCs using data from the National Poison Data System (NPDS). The study included intentional single-substance ingestions of both brand-name and generic forms of SUDS and diphenhydramine among children ≤ 19 years. We compared the number of calls, clinical effects, disposition, and management strategies for SUDS (pre: 01/01/17 to 12/31/17 vs. post: 01/01/18 to 12/31/18) and diphenhydramine (pre: 08/01/19 to 07/31/20 vs. post: 08/01/20 to 07/31/21) ingestions 12 months before and after the introduction of the respective social media challenges. Differences in proportions were compared using the Chi-square test. Results: During the study period, 469 ingestions of SUDS and 5,702 ingestions of diphenhydramine were reported. Post-challenge periods saw an increase in both SUDS (pre: 82 vs. post: 387;372% increase) and diphenhydramine ingestions (pre: 2,672 vs. post: 3,030;13% increase). While there were no significant changes in moderate or major clinical outcomes, hospitalizations increased post-challenge for both SUDS [pre: 4 (4.9%) vs. post: 33 (8.5%);p = 0.25] and diphenhydramine [pre: n = 904 (33.8%) vs. post: 1,190 (39.3%);p Conclusion: Pediatric ingestions reported to U.S. PCCs and hospitalizations increased coinciding with the introduction of Tide Pod® and Benadryl® challenges. While causality cannot be definitively established, it is essential for pediatricians and parents to be aware of these challenges and educate vulnerable children about the harmful effects of participation in such challenges.

Opportunities, Challenges, and Countermeasures of China Myanmar Economic and Trade Cooperation under the Background of RCEP

China and Myanmar are geographically adjacent and have close economic and trade cooperation. China has been Myanmar’s largest trading partner and largest source of investment for many consecutive years. With the official entry into force of RCEP (Regional Comprehensive Economic Partnership) for Myanmar on May 1, 2022, the reduction of trade tariffs on goods and flexible rules of origin between China and Myanmar will undoubtedly bring more practical results to China Myanmar economic and trade cooperation. However, the implementation of RCEP in Myanmar may face a series of challenges such as poor business environment, weak human resource management, and outdated infrastructure construction. Finally, the article provides countermeasures for China Myanmar economic and trade cooperation from three aspects: optimizing the business environment to attract Chinese investment, increasing investment in education and training to improve labor quality, strengthening infrastructure construction to enhance economic support.